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"Lack of security remains a critical issue for the population and we have not seen any improvements in 2013," said Gherardo Pontrandolfi, head of the ICRC delegation in Afghanistan. "For example, civilians are being caught in crossfire and are often unable to reach health-care centres simply because it is not safe to move about. All too often, care facilities are targeted, and services disrupted, particularly in remote areas."

The ICRC's priorities in its current work in Afghanistan include ensuring not only that civilians are spared from harm, but also that all parties to the conflict understand and accept that the safety of, and respect for, medical personnel, facilities and transport are paramount. Gaining acceptance, security and safe access for Red Cross and Red Crescent workers is crucial, so that they can carry out their humanitarian work in safety, and in accordance with the core principles of neutrality, independence and humanity.

Humanitarian organizations also have to consider how to operate safely in an increasingly insecure environment. The attack on the ICRC's sub-delegation in Jalalabad in May 2013 led to a re-thinking of the organization's presence in the country, so as to ensure that key activities such as support to health services, visits to detainees and other protection-related work, assistance programmes and interaction with Afghan Red Crescent partners could continue at optimum capacity, while at the same time reducing staff exposure to risk.

Managing the fine balance between taking action â with the inherent danger of being in the wrong place at the wrong time or, worse, becoming a direct target â and operating from a distance, by "remote control," is a challenge for all those involved in humanitarian work in conflict zones.

"We need to keep in mind our long-term presence in the country," explained Mr Pontrandolfi. "We have been working in Afghanistan for nearly 30 years, and are well known to all the parties. Our intention is to remain for as long as there are needs to be addressed. Of special concern is the suffering of people living in remote, conflict-affected areas that are hard to reach."

Despite the security constraints and difficult access to many parts of Afghanistan, the ICRC remained fully operational throughout 2013, working alone or in partnership with Afghan Red Crescent staff and volunteers (see facts and figures below). "There is no room for arrogance or complacency," said Mr Pontrandolfi. "We have a job to do, and the aim is to do it as effectively as possible, without putting the lives of our staff or partners at unnecessary risk."

The months ahead, however, are unlikely to see any improvement in the already extremely fragile security situation. Upcoming presidential elections, the ongoing drawdown of international forces, the likelihood of reduced donor funding, endemic poverty and high unemployment are only some of the factors that will continue to haunt Afghanistan â to say nothing of the recent attack on the restaurant in Kabul in which civilians and foreigners appeared to be the target.

"The future does not look promising," said Mr Pontrandolfi. "The situation for ordinary Afghans as well as for humanitarian workers remains precarious, but we are not packing up and going. However, we will have to ensure the right balance between risk and action in order to remain as close as possible to people in need."

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In 2013, the ICRC:

visited 49,490 detainees, 1,441 of them for the first time; and helped 30 ex-detainees return home;distributed clothing, blankets, hygiene items, and other essential supplies to some 29,000 detainees in places of detention visited by the ICRC;registered over 8,900 new patients, including 1,203 amputees, at the seven ICRC physical rehabilitation centres;created job opportunities for more than 10,600 people participating in cash-for-work projects;provided one-month food rations and household items for more than 11,460 families displaced by conflict or natural disaster;briefed more than 12,500 weapon bearers, political authorities, community elders, religious leaders, members of civil society, and people receiving aid on its mandate and work;maintained its support for Mirwais and Sheberghan hospitals, which admitted 52,000 inpatients and saw over 264,000 outpatients between them. A total of 16,253 operations were performed in the two hospitals;installed or renovated water supply systems to bring clean water to over 383,000 people in rural or urban areas.